Calhoun B C, Jennings B M, Peniston J, Patience T, Pulos E, Hume R, Perez R
Madigan Army Medical Center, Tacoma, WA 98431, USA.
Mil Med. 2000 Jan;165(1):45-8.
To evaluate the utility of an interdisciplinary clinic in improving perinatal outcomes for all pregnant patients of junior enlisted rank (E4 and below) in response to previous reports that this group is at higher risk for adverse outcomes.
The study population included all junior enlisted active duty patients (E4 and below) delivering between January 1, 1993, and June 30, 1996. Outcomes for patients receiving care in a focused active duty obstetrical clinic were compared with outcomes in similar cohorts of senior active duty patients (E5 and above) and non-active duty pregnant patients. Evaluation was based on perinatal outcomes, including chorioamnionitis, postpartum hemorrhage, intrauterine growth retardation, cesarean delivery, preterm delivery rates (< 37 weeks), postterm delivery rates (> 41 weeks), postpartum days, mean gestational age at delivery, mean delivery weights, Apgar scores at 1 and 5 minutes, preeclampsia, and premature labor. Variables with potential to confound perinatal outcomes were also studied. Confounding variables included tobacco use, gestational diabetes, chronic hypertension, thyroid disease, history of substance abuse, and alcohol use. Power analysis accomplished before initiation of the study showed adequate sample size (> 240 patients in each group) to demonstrate statistically different rates of preterm delivery. Statistical analysis was done using the chi 2 test for categorical variables and Student's t test for continuous variables.
There were no statistical differences between junior active duty patients, senior active duty patients, and non-active duty patients in preterm delivery and other outcome variables.
The focused obstetrical clinic, conducted for junior enlisted soldiers by a senior nurse practitioner, appears to provide an intervention that ensures perinatal outcomes equal to those of both the non-active duty and the senior active duty population.
鉴于之前有报告称初级士官（E4及以下）这一群体不良结局风险较高，评估跨学科诊所对改善所有该职级孕妇围产期结局的效用。
研究人群包括1993年1月1日至1996年6月30日期间分娩的所有初级士官现役患者（E4及以下）。将在专注于现役产科诊所接受护理的患者结局与高级现役患者（E5及以上）和非现役孕妇类似队列的结局进行比较。评估基于围产期结局，包括绒毛膜羊膜炎、产后出血、宫内生长受限、剖宫产、早产率（<37周）、过期产率（>41周）、产后天数、平均分娩孕周、平均出生体重、1分钟和5分钟阿氏评分、先兆子痫和早产。还研究了可能混淆围产期结局的变量。混杂变量包括吸烟、妊娠期糖尿病、慢性高血压、甲状腺疾病、药物滥用史和饮酒情况。研究开始前进行的功效分析表明样本量充足（每组>240例患者），足以证明早产率存在统计学差异。分类变量采用卡方检验，连续变量采用学生t检验进行统计分析。
初级现役患者、高级现役患者和非现役患者在早产及其他结局变量方面无统计学差异。
由高级执业护士为初级士官开展的专注产科诊所似乎提供了一种干预措施，可确保围产期结局与非现役人群和高级现役人群相当。
